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May 8, 2012 -- Many moms of chubby toddlers don't realize their babies are large for their age, and this misperception may be setting the stage for their tots to grow up to be overweight or obese, a new study shows.

Nearly 70% of moms inaccurately assessed their toddler's body size when selecting an image they thought reflected their child's body size. Moms of overweighttoddlers were more than 88% less likely to accurately perceive their child's body size when compared to moms of toddlers with a healthy weight, the study shows.

Overall, more than two-thirds of moms were satisfied with their toddler's body size. More mothers of healthy-weight or overweight toddlers were likely to be satisfied than mothers of underweight toddlers.

Erin R. Hager, PhD, assistant professor of pediatrics at the University of Maryland School of Medicine in Baltimore, looked at how 281 moms viewed their child's body size. Participants were recruited from a suburban Special Supplemental Nutrition Program for Women, Infants, and Children clinic and an urban pediatric clinic serving predominantly low-income families. Babies were close to 2 years old, on average. Moms ranged in age from 18 to 46 and most were overweight or obese.

The new findings appear in the May issue of Archives of Pediatrics & Adolescent Medicine.

"Most of the moms were inaccurate in knowing their child's true body size, but were highly satisfied with their child's size," Hager says. Those who were not satisfied with their child's size typically wanted their kids to be bigger.

"This is not good if the child is already at a healthy weight or overweight."

Perceptions guide behavior, she says. "If you desire your child to be bigger, you may encourage them to gain weight."

Not really, Hager says. "Many people believe that a chubby baby is a sign of good parenting, but this is not accurate anymore."

Parents may think their kids will grow out of it, but that is not always the case. Chubby tots are more likely to become overweight or obese adults -- especially if their parents mistakenly see them as underweight and try to have them gain weight.

As it stands, about 1 in 3 kids in the U.S. is overweight or obese before age 5. The rate of childhood obesity in the U.S. has tripled since the 1970s.

Perceptions Guide Behaviors

"This is the elephant in room," says Sarah E. Messiah, PhD, MPH. She is a perinatal/pediatric epidemiologist at University of Miami Miller School of Medicine in Florida. "There is a huge disconnect between a parent's perception of their child's weight and their child's actual weight."

The public health implications are enormous. "If a parent can't even identify that their child is overweight, they won't be able to prevent their child from becoming overweight or obese."

Prevention starts at home, she says: "You can't start young enough anymore with obesity prevention. It is crucial to identify the problem if there is one.

Her advice? Ask your child's pediatrician where your child is on the growth chart for BMI.

"Anything above the 85% is a red flag," Messiah says.

Of course, you shouldn't put a toddler on a diet, but that doesn't mean you are powerless.

"Get them moving and stay away from fruit juice and soda," she says. "If they learn to drink water first, they will like it."

Encourage Physical Activity, Healthy Choices

Sarah Hampl, MD, is the medical director of weight management services at Children's Mercy Hospitals and Clinics in Kansas City, Mo. "From a very early age, moms don't accurately perceive their toddler's body size or weight status," she says.

This misperception may result in encouraging children to eat more than they need for age.

"Parents have more influence when kids are younger," she says. "This is the prime time to encourage fruits and vegetables. We need to make sure that food offerings are the healthiest they can be and not influenced by an inaccurate perception."

The pediatrician also has a role in helping to shore up any disconnects. "They can bring this up and gauge what parents think of their child's weight status and either validate or gently redirect them."

PSA Campaign Can Help Moms Identify Healthy Weight

Eliana M. Perrin, MD, MPH, of the University of North Carolina at Chapel Hill, wrote an editorial accompanying the new study. Her solution to the problem is a public health campaign.

"I am imagining posters showing photographs of children of all ages between the 5th and 85th percentiles saying, 'I'm at a healthy weight!' This type of campaign may help reset our nationally normed pictures of health, helping parents appreciate healthy undulations of weight," she writes.